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Medicine as a career has everything – it is demanding, rewarding, challenging and uplifting but never dull, and most physicians wouldn’t have it any other way. The increased complexity of medicine creates many demands, from academic excellence to superb communication skills. As a physician, you have the opportunity not only to cure and treat diseases, but also to help patients whose conditions cannot be cured to live their lives to the full. A wide variety of career paths are available to match every doctor’s interest – from basic clinical research to those for whom medicine’s primary appeal is working daily with patients.
There has never been a more exciting time to become a physician – the reorganisation of junior doctor training will bring new opportunities, breaking down the barriers between specialties and allowing new training routes to open up. From August 2005 all newlyqualified doctors have entered a two-year competence-based Foundation Programme, covering clinical skills, professional practice, and developing and maintaining good relationships with patients and colleagues. Successful completion of the first year will lead to registration with the General Medical Council (GMC).
Following the foundation years, it is envisaged that doctors will enter a two-year period of core medical training in acute and general medicine. Within this framework there will be ‘themed’ training programmes available for trainees with a particular interest in certain specialties, eg neurology. Assessments undertaken during this period will include elements of the MRCP examination, an essential requirement for all physicians. The new training posts will include posts designated for doctors intending to undertake research.
At the end of the two-year period of core training trainees will be allocated to train further in one of medicine’s 29 specialties. At the successful completion of training doctors will receive a certificate of completion of training (CCT) and will be eligible to apply for consultant posts. For full curricula details see the website of the Joint Committee for Higher Medical Training.
Of medicine’s 29 specialties, the four largest are geriatric medicine, cardiology, gastroenterology and respiratory medicine, each with hundreds of consultant posts. Some specialties such as allergy and metabolic medicine are very small, with less than 30 consultants to cover the UK. The yearly physician census gives numbers in each specialty and posts are advertised in publications such as the British Medical Journal, Hospital Doctor and specialty journals.
Consultant physicians work hard. About half have on-call commitments and most put in long hours (often over and above their contract), typically 54 hours per week, rising to more than 60 hours per week for those in the acute main specialties. Women make up 23 per cent of the consultant physician workforce (varying between eight per cent in cardiology to over 60 per cent in palliative medicine) but this is rising consistently each year. Although the opportunities for flexible training and working have been insufficient, this is changing with the realisation that the NHS must retain talented professionals.
The best aspects of being a physician include the huge variety of roles available, for example invasive cardiology, genitourinary medicine, clinical genetics; the intellectual demands and rewards; and the opportunity to contribute to service development in a rapidly changing environment. The worst aspects include lengthy training with tough assessments; the aforementioned high workload in some specialties; and frustration when resources are inadequate.
Medicine is also an increasingly international occupation. In the UK doctors work with healthcare staff from other countries and cultures, and there are opportunities to work and study all over the world – opportunities that increase the variety and depth of the experience of being a physician.
The 29 specialties and subspecialties in medicine are:
Dr Patrick Cadigan FRCP is director of general professional training at the Royal College of Physicians and consultant physician at Sandwell General Hospital, West Bromwich.
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